Vancomycin resistant enterococci (VRE), first reported in 1988, has emerged as a leading nosocomial pathogen. While VRE plagues oncology, transplantation, and intensive care units, it is an uncommon pathogen in newborns. VRE bloodstream infection was seen in our Regional Neonatal Intensive Care Unit(RNICU) in November 1995. This was followed by an outbreak of VRE colonization in our RNICU with a peak colonization rate (incidence) of 66% within 3 weeks. Point prevalence and the natural history of VRE colonization was studied by obtaining monthly perianal cultures on all babies in the unit after intense review of infection control measures with the staff. Of the 193 babies cultured, 53 had serial cultures (range 2-9; median=2). Of the 18/193 (9%) babies who were culture positive, 9 were positive with the first culture (of which 3 were persistently culture positive); the other 9 became positive after≥1 negative culture. The table shows point prevalence and colonization rates.
These data show that strict infection control measures can significantly decrease the point prevalence and the rate of colonization of VRE. However, as shown in adults, VRE can persist in a neonatal intensive care unit as an endemic nosocomial pathogen despite strict infection control measures.
